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Pavord ID, Beasley R, Agusti A, Anderson GP, Bel E, Brusselle G, Cullinan P, Custovic A, Ducharme FM, Fahy JV, Frey U, Gibson P, Heaney LG, Holt PG, Humbert M, Lloyd CM, Marks G, Martinez FD, Sly PD, von Mutius E, Wenzel S, Zar HJ, Bush A. After asthma: redefining airways diseases. Lancet 2018; 391:350-400. [PMID: 28911920 DOI: 10.1016/s0140-6736(17)30879-6] [Citation(s) in RCA: 674] [Impact Index Per Article: 112.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 02/26/2017] [Accepted: 03/07/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Ian D Pavord
- Respiratory Medicine Unit, Nuffield Department of Medicine and NIHR Oxford Biomedical Research Centre, University of Oxford, UK.
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain; CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Gary P Anderson
- Lung Health Research Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Elisabeth Bel
- Department of Respiratory Medicine, Academic Medical Center, University of Amsterdam, Netherlands
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Paul Cullinan
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Francine M Ducharme
- Departments of Paediatrics and Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada
| | - John V Fahy
- Cardiovascular Research Institute, and Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Urs Frey
- University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Peter Gibson
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia; Priority Research Centre for Asthma and Respiratory Disease, The University of Newcastle, Newcastle, NSW, Australia
| | - Liam G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Patrick G Holt
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Marc Humbert
- L'Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Paris, France; Service de Pneumologie, Hôpital Bicêtre, Paris, France; INSERM UMR-S 999, Hôpital Marie Lannelongue, Paris, France
| | - Clare M Lloyd
- National Heart and Lung Institute, Imperial College, London, UK
| | - Guy Marks
- Department of Respiratory Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Fernando D Martinez
- Asthma and Airway Disease Research Center, The University of Arizona, Tuscon, AZ, USA
| | - Peter D Sly
- Department of Children's Health and Environment, Children's Health Queensland, Brisbane, QLD, Australia; Centre for Children's Health Research, Brisbane, QLD, Australia
| | - Erika von Mutius
- Dr. von Haunersches Kinderspital, Ludwig Maximilians Universität, Munich, Germany
| | - Sally Wenzel
- University of Pittsburgh Asthma Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital and Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Andy Bush
- Department of Paediatrics, Imperial College, London, UK; Department of Paediatric Respiratory Medicine, Imperial College, London, UK
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Giacoia GP, Mattison DR. Newborns and drug studies: the NICHD/FDA newborn drug development initiative. Clin Ther 2006; 27:796-813. [PMID: 16117987 DOI: 10.1016/j.clinthera.2005.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Progress has been made in research on the effects of drug therapy on pediatric patients, but neonates are still an understudied population. Those most likely to receive drug therapy (eg, preterm infants) are least likely to be studied. OBJECTIVES The purposes of this article are to summarize an initiative developed jointly by the National Institute of Child Health and Human Development (NICHD) and the US Food and Drug Administration (FDA) and to introduce a series of articles developed as a result of this initiative. METHODS Information for this article was gathered from the proceedings of a workshop cosponsored by the NICHD and the FDA that took place March 29 and 30, 2004, in Rockville, Maryland. RESULTS : Dosing based on use in adults and older children has resulted in adverse events among newborn infants, and may have long-term effects. Moreover, formulations appropriate for use in neonates are often unavailable, and compensatory efforts such as mixing crushed tablets into formula may interfere with accurate dose delivery. Under the Best Pharmaceuticals for Children Act of 2002, government agencies work with experts in pediatrics and pediatric research to develop and prioritize a list of off-patent drugs for which pediatric studies are urgently needed. Four such listings were published in the Federal Register from January 2003 through January 2005. The NICHD and FDA have also initiated the Newborn Drug Development Initiative (NDDI), a multiphase program to determine gaps in knowledge concerning neonatal pharmacology and clinical trial design and to explore novel study designs for use in newborns, with the ultimate goal of increasing our knowledge about the safety and efficacy of drugs used to treat newborns. CONCLUSIONS Most drugs used to treat newborns still lack appropriate dosing, efficacy, and safety studies in this vulnerable population. The NICHD and FDA developed the NDDI as an ongoing process to identify and suggest strategies for addressing obstacles to conducting drug trials in the newborn.
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Affiliation(s)
- George P Giacoia
- Obstetric and Pediatric Pharmacology Branch, Center for Research for Mothers and Children, National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD, USA.
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Holt PG, Sly PD, Martinez FD, Weiss ST, Björkstén B, von Mutius E, Wahn U. Drug development strategies for asthma: in search of a new paradigm. Nat Immunol 2004; 5:695-8. [PMID: 15224096 DOI: 10.1038/ni0704-695] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The spiraling costs of asthma treatment seem set to continue rising, given the equivocal performance of the latest generation of specific anti-inflammatory drugs in trials in adult asthmatics. We argue that the continuation of this trend is inevitable unless there is a substantial realignment of entrenched drug development policy in the pharmaceutical industry and a parallel shift in licensing policy by regulatory authorities to encourage the development of drugs capable of halting the progression from acute to chronic asthma when the disease first manifests in childhood. The theoretical framework for such an approach, including proof-of-principle data from studies in children with early-stage disease and a range of candidate drugs, already exists. What is needed is informed debate on the risks versus potential benefits of this approach.
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Affiliation(s)
- Patrick G Holt
- Telethon Institute for Child Health Research, and Centre for Child Health Research, The University of Western Australia, Perth, Western Australia.
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Szefler SJ, Whelan G, Gleason M, Spahn JD. The need for pediatric studies of allergy and asthma medications. Curr Allergy Asthma Rep 2003; 3:478-83. [PMID: 14531968 DOI: 10.1007/s11882-003-0058-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
For many years, clinicians have accepted the fact that most medications do not have dosing guidelines for children younger than 12 years of age. Recently, there has been a great effort to correct this deficiency. With the introduction of the 1997 Food and Drug Administration Modernization Act, a provision was established to grant additional market exclusivity to pharmaceutical firms that performed the required studies that would lead to improved labeling of medications for children. This effort has resulted in a significant advance for the management of asthma and allergic disorders in children. Several allergy and asthma medications are now approved for use in children as young as 1 year of age, with studies currently being conducted in younger age groups. In this review, we discuss the background for this effort and the continuing impact it will have on the future management of allergy and asthma in children.
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Affiliation(s)
- Stanley J Szefler
- National Jewish Medical and Research Center, 1400 Jackson Street, Room J304, Denver, CO 80206, USA.
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